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HomeMy WebLinkAboutBuilding Permit # 10/17/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER /111 t� ti APPLICATION FOR PLAN EXAMINATIOII n m PeTrMK No#, Date Received SS.�cHus� Date Issued: !� 1 IMPORTANT Applicant must complete all items onth�s page o m"r, �r �, '° ^` r�Hra� �.... .;, ��:� ��. i - �= _� ,,,r j`^s '``�,.,', - � ., ✓'` r �, „xs , �yTMs- u`r ty i, " l a- .r .,�. .r'c y "°:' rb;f'Y � ✓'; "�; ':r �a '``zs.5 � "'k "' .G' s"r �� Pr � _ .T r r r �c� �� 5 NR R, - �� ' � � MAP PARCEL ZONING ffSTRICT Hrstoric E5 � �F yes "no acfine _, .I?.Vrllagey .;yds � . T YPE OF 1MPROVEMV NT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial C"Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic,' ❑ Well ❑ Floodplain ❑Wetlands ❑" Water Ii�ec Drstrrct ❑ Wateryewe s � --- v �a ®ESCIZIPTI®N ®F V�IORK T® �E P�RFORI�ifEI]: i cXD - Identification- Please Type or Print Clearly OWNER: Name: ! ° " -1 Phone: Address: Contractor Narne t Phone I l N Address" �G 2 fad mak/ y r r r Sup'`ervisor'srConstruction``L�cense ` F� Exp l Date� f` � ��� � { - Exp Date - ARCH ITECT/ENG[NEER Phone Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL,ESTIMATED COST BASED ON$925.00 PER S.F. Toted Projeot Cost: $ FEE: C cfc 0 o 1 4 q"-1 Receipt No.: 1 �T N Per cont #Yzg vi$ unFegisfered contra � ie access to the guaranty fund afur gin nqr S[gnafure of coritrac or -_ _.I O R T N N .Town of _ . . over o oh ver, Mass, 1 COCMICNIWICK �' A-re a r4�,��(`� S V BOARD . PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT ...........5.. A.&V.........�. a.!. . �.........I.................. BUILDING has permission to erect ...... buildings on .. �,, .��„�, „+ Q S Foundation .................... ...., .�.... ... � Rough to be occupied as ......er .1 ..... .,. .. ............................................................ Chimney provided that the person accepting this permit shall in every.respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECrRICAE. UNLESS CONST ON ST Rough Service .. .. ........ .... Final BUILDING INSPECT GAS IN5 Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE UEPP Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information )� Please Print Legibly Name (Business/organization/Individual): (A. / ,/VJ` t �- C Address: �"T'I—%-­, fVIX'�r-t A S 7 City/State/Zip: L� Phone#: y b ! r Are you an employer?Check the appropriate box: Type of project(required): It ham a employer with employees(full and/or part-time).* 7. ❑New construction 2. am a sole proprietor or partnership and have no employees working for me in ❑1 l S. F1 Remodeling any capacity.[No workers'camp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13. Roof repaixS These sub-contractors have employees and have workers'comp.insurances 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#1 must also fill out the section below showing their workerscompensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iain an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: i - S } Policy#or Self-ins.Lic,#: tA-C• 1/0 • 1,0, %XD:3 J -� � Expiration Date: Job Site Address: 6 55 SV- f 1 &ac ( _ 44 ') City/State/Zip; Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MGI.,c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. tu Si are: �p Date: { Phone#: C] Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk A.Electrical Inspector 5.PIumbing Iuspecttsr 6. Other Contact Person: Phone#: ,r PROPOSAL/ESTIMATE :a 170 Main St,North Reading,MA,01864 � Jr pf R 781-321-1991 V I N T E R [--[ I L L Claudio Araujo—License CS 105185 ,r',r:ti rcnr, i:,::rr•� r :tra+;;: rc:�sr. r.r*ac;. www.winterhillgc.com STACEY TRINGALI Email: STACEY.TAGERMANLGMAIL.COM 655 SOUTH BRADFORD ST NORTH ANDOVER Plione:9785000902 Date: 116 Job location: '.•' Shingle Roof Tear Off:. The following paragraphs describe the work that will be performed, • Protect wall,decks,patio,plants using larps(winter hill is not responsible to protect any belongs into de attic and clean up) • Remove existing shingle roof on the entire house • Install an 8 inch drip edge on all leading edges(Color:___) • Install 6 feet of ice&water shield on front leading edges&valleys • Hurricane Nailing:6 Nails per Shingle • Install starter strip on all leading edges. • Install felt buster on all areas not covered by ice&water shield • Install New Ridge Vent • Install new vent pipe flanges • Replace any rotten or damaged roof decking plywood(we allow 32SF at no charge,$65.001sheet thereafter) • Replace any rotten or damaged roof decking ledger boani(we allow 32 ft,at no charge,$3.501ft.thereafter). • Install new GAF Timberline High Definition Architecture;shingles a Rmoovs:r,xPiling lead flw hinr#on vliinlney,install Ice&Waler Shield,step Ilasliing,Incl grind New Umd Fla!-hirxl inio l.',hriaulry Warranty included in contract -(x ) System Plus • Shingle Color= • All debris will be removed from the prope�{y Cost for labor Material for New Shi>�gle Roof: $ 14,400.00 Payment Terms: f� i 17. 113 deposit due upon signing contract: ---- 113 payment due upon start of job: $ 113 payment due upon completion of job: $ _ Total Amount Agreed To Be Paid: $ Work Scheduled to Begin: TBD Warranty:GAF.guarantees all material for lifetime'and work perfonned for a period of fifteen(15)years.If any problems occur we wlll cover the cost of all labor and material to correct the problem and meet the customer's satisfaictlon. 1-//ell A,� ClaudioAraGjo,Project Manager Ninter Hili General Contractor,Inc. Date Home Owner Date YIPJ� cstsc:vea Financing Payment types accepted Available The law requires the following FOUIU ME:N items to be included in any contract between a homeowner and a registered home irnprove€men(contractor for home improvement work subject to MGL c. 142A: 1.The complete agreement between the contractor and the owner and a clear description orally other documents which are part of the agreement. 2.The full names,federal I.D.number(if applicable),addresses(NOT P.O.Box numbers),of the parties,the contractors registration number,the narnc(s)of€lie salesperson(s)involved,i f any and the date the contract was executed by the parties. 3.The date on which the work is scheduled to begin and the date the work is scheduled to be substantially completed. 4.A detailed description ofthe work to be done and the materials to be used. 5.The total arnount agreed to be paid for(lie work to be perl'orcned under the contract. 6.A lime schedule of payments to be made under the contact and the amount of each payment stated in dollars,including any finance charges,Any deposit required to be paid in advance of the start of llre work SHALL NOT exceed one-third or the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No Inial payment shall be demanded until the coniracl is completed to the satisfaction oral]parties. 7.All parties must sign the contract. 8.A clear and conspicuous notice stating: a.That all home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor ur subcontractor relating to a registration should be directed to; Office of Consumer Affairs and Business Regulation Ten Park Plaza,Suite 5170 Roston,MA 02116 Phone,(617)973-8700 b.The comractor's registration number must be on the first page of the contract. c.The homeowner's three day cancellation rights under MGI,c 93 s 48;MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d.All warranties on the owner's rights under the provisions of and MGL e. 142A. e.In ten point bold type or larger,directly above the space provided for the signature,the following statement: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. f:Whether any lien or security interest is on the residence as it consequence of the contract. 9.An enumeration of such other matters upon which the owner and contractor may lawfully agree. 10.Any other provisions otherwise required by the applicable laws of the Commonwealth. 11.Permit Notice:livcry contract shall con€ain a clause informing the owner of the following: a.any and all necessary construction-re[ated permits; b,that it shall be the obligation of the contractor to obtain such permits. c,that owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to lite Guarantee Fund. 12.Acceleration orpaymenl:No contract shall contain an acceleration clause under which any part or al]of Ibe balance not yet due may be declared due and payable because the holder deems himself to be insecure.However,where the contractor deems himself io be insecure he may require as a prerequisite to continuing said work that the balance of E'unds title under the contract, which are in possession of the owner,shall be placed in a joint escrow account requiring the signatures ofthe home improvement contractor and the owner Ibr withdrawal. 13.No work shall begin prior to the signing o#'the contract and transmittal to the owner of a copy of such contract. 14.Arbitration:If the contractor determines that in the event ora dispute,the contractor wishes the dispute to be settled by arbilralion,this fact must be signified on the contract anti both the tont actor and owner shall sign this clause separately.The following format is acceptable(in 10 point type or larger); "Tire contractor and the homeowner hereby mutually agree!a advance that in the event that etre contractor has a dispute concerning this contract,the c•onmactor may subunit such dispute ro a private arbitration service which Inas been approved by the Office of Consumer Aff drs and(business Regulation and the consumer shall be required to subadt to serch arbitration as provided in R1GL c 142A. Owner. C l l J contractor: 1V077CE. The signnho es of the parties above apply arlP to the agreeatefrt oj'tlre parties to atteraate dispute resobrtionr iuilialed by the contractor. The orruer may initiate c:lternwirc rtisprrre --esolrrtion even where This section is nol signed separately by die parlies." North Andover MIMAP October 17, 2016 b lr filer � �' v r ,: N ^ r J �„' ✓ `� b'Y� p`r p�' ,r r��'✓) a v / �✓�„ `� ��":ID�i �`� v r ✓ r°,�✓P '' r `v`r�.w'" , Q 41 � P✓ u , A ,+ d ✓ v p �; � d f � /1 Y l , rt/ v 00 ✓ ° ✓ f lQ r �� „YAC ay r° " �" rq ,w` y' , '' d d' , (, `,�" ,G e re r "1 a p ,, a , r` r✓,;✓ r s.",.P1 i r / r rro, r o7 "0' v �/"x�. ,_,.0 .�' ";f� '✓err",r:+' f. 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Boas ter �j MVPC Do Zoning Overlay Zoning []Municipal Boundary Adult Brdertainment Distric Busirto s 1 District 9 Machine Shop Village Ove Buliqei s 2 District Horizontal datum:MA Streeplane Coordinate System,Datum NAD83, Rail Line Vh Watershed Protection Dist M Busirn.s 3 District Meters Data Sources:The data for this map was produced by Merrimack Intarsiales Historic Mill Area N Busine s 4 District AORTH Valley Planning Cornmisslon(MVPC)using data provided by the Town of .,..,..1 0 Medical Marijuana 0 Genera Business DistrictOf s4t u qNorth Andover.Additional data provided by the Executive Ogtce of SR 0Downtown Overlay District rd Plivir Commercial Dev may, b. "'.4, Environmental AffalralMassGIS.The informallan depicted on this map is C)Historic District Conido Development Dist Oa,{. Ing purposes only.It may not be adequate far legal boundary Z. far Plana Roads Osgood Smart Growth(40 Conido Development Dist 6 -- in definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Easements Hydrographic Features lR Conido Development Dist 1. 0 MAKES NO WARRANTIES EXPRESSED OR IMPLIED,CONCERNING Indusai I 1 District 41 * THE ACCURACY,COMPLETENESS,RELIADILDY,OR SUITABILITY L7 Parcels Streams Indusiri 12 District 1i w i OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Wetlands r,") Industri 13 District >r, rat^ 4 sb* ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Irl Indusiri 1 S District o "'"`"""Pw THIS INFORMATION Exempt Lands Residei ce t District �,' ��>•rc�� ,�(y Resde co 2 District `r5'ACHUS� Reside ce 3 Dlsir!at da ce 4 District 1"=576 ft �(1]� da ca 6 District Y p die co 6 Dlsirict �.,,a'esidantial District North Andover MIMAP October 17, 2016 a�fi ,G •'r'�Ir,��:= �J:� ,ire',.•"....�"sJ� .. ::;-->�;Jcr. f,. _ k'+J+r •^;�>�af>5;"•:'�.- �.,_. •':~isle^•::.'W�."ai'�- �r, {r ( J ,I, t ai, I -_- •• al, 104.D-0147 P.rt 643 SOUTH BRADFORD ST r, :,;.,�h 104.[71-0012• '^N.�,t ••'•ati �^Jnr,✓:,,i1....1'>M�°.:: ..`.,:^..k��F;,," l ywtF.,r/. �IJ,f r , J£tJ,rr ..'..>,sl✓,` J d' Its 655 SOUTH BRADFORD ST -0148 Al aI W'V J ,.. . Ski < G Sy)^ a`!' ✓. f .,.,x :rk}.✓,✓, , 'x`,JA=r ..... :vtiJ4': ,_ ,,..,... .__ 0- y tib, ;'•raJr,. , ..:;o&.,I.t...:�+lr:: .: '...;• o 104 D 0013, ' it al <':alf 667 SOUTH BRADFORD ST � 104.D-0149 .�, air '>r4lfe I Jf< Aye. ,��Mrlr4� n5•r�r,.""" ",�1 :TU'M",^...4.II+� •`'•,5� , 104.4-0150 MVPC Be Zoning Overlay Zoning C'J Miardpal Boundary Adult Entertainment Distric Bustno s 1 District Machine Shop Village Ove T� Buslne s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rall Lino DI Watershed Protection Dist M Busing s 3 District Melons Data Sources:The data for this map was produced by Merrimack Interstates C.)Historic Kill[Area M Busfmn s 4 District tkoRTM Valley Planning Commission(MVPC)using data provided by the Town of "--I 0 Medical Marijuana M Genu Business District Or «ro "Q,,y North Andover.Additional data provided by the Executive Office of SR Cj Dovmtown Overrlay District N Planne Commercial Dev ,2, tt r°+4 00 Enviromnental AffairsfMassG1S.The Information depicted on this map is Roads (3 Historic District Couldo Development Dist ,# b L for planning purposes only. It may riot tae.adequate for legal boundary Osgomd Smart Growth(40 -% Carrillo Development Dist O —• "` IN definition or regulatory interpretation"THE TOWN OF NORTH ANDOVER t"r..Easements Vd Couido Development Dist I.- » 9 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Hydrographic Features Indus:311 District k y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Q Parcels Streams :ndus12 District it ., OF THESE DATA.THE TOWN OF NORTH ANDOVER.DOES NOT f7 lndusld 13 District Wetlands w^ no t"' M ASSUME ANY LIABILITY ASSOCIATED WITH THE 118E OR MISUSE OF E�Reside I S Di THIS INFORMATION Exempt Lands Rosldo ce 1 District �i o�..rro w�w�1� Reside car 2District iS'SACNUS�� "Reside ce3 District de ce4 District V=61 ftde ce s District s de cee 8 Disldct ,,,,a esidrimlr l Dishlct VO/17/2016 11:12 FAX Michals Insurance a 0001/0001 WINTE-2 OP ID:JJ CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) 1011712016 TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUcelx CONTACT Crown Insurance A_ enc Inc:. NAME: _ _ ` .� y�.___� Bradly S.Michals Insurance PHONE FA% Agency,Inc. _LAL _o Ext:617-924-1100_..._........ N, 677-926-2162 85 Main Street E-MAIL Watertown, et 02472 ADDRESS: --- -.._.....-- -- -- - ..,.-._................................... Crown Insurance Agency,Inc, INSURER(SIgFFORDFNG COVERAGE _--_ i— NAIL A _-_.__..................-.............-.-----------------.---------------- InlsuRERa:Aeadia Insurance CotTlpanY_._._.......____ - - -- ENSURED Winter Hill General Contractor INSURERB:Arbella Insurance Co. ?17000 Claudio Mcuhna Araujo — -----_---�-- —..............�___._._.... .__....-.. :,..-_-_ ---.--_..-- la Main c INSURER 0:Northland Insurance North Reading, MA 01864 INSURER D: ENSURER E ---------- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE: LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.L)MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _ _ __ ___ ______ __ _ __ _ ---.-_.-_-._.._._._._._...__..._------ - - T-iNR.': .............. TYPE OFINSURANCEWIAN�LlStrt RI' POLICY NUMBER -........- .. MM!WYYYY i MM/0D YY I LIMITS C i X COMMERCIAL GENERAL LIABILITY i I � I EACH OCCURRENCE $ 2,000,000 -._ - ---a _. - CLAIMS-MADE ' X ` OCCUR ' IWS274235 02/13/2016 10211312017 I DAIrAGE To I 100,000 i,..., -..J I LPREMIS�S_(Ea occurrenmeh,.. .$. _......_n?_.. ..... E MED EXP(Any one person) !$ 5,00 PERSONAL&ADV INJURY 1$ 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: I � ! GENERAL AGGREGATE j 5 2,000,000 PRO -. -._... — -- LX POLICY JECT L_.._-_ LOC j ' PRODUCTS-COMPIOP AGG S 2,000,000 -_ ..,.5 .�._-..�..__.__. I OTHER: I ! i COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY [ I s 1,000,000 B ANY AUTO I 1020001551 041091201 fi!0410912017 BODILY INJURY(Per person) [S ALL OWNED X SCHEDULED I ~BODILY INJURY(Per accident 5 i.- AUTOS ;-__..)AUTOS ------------- --- : X X I NON-OWNED I PROPERTY DAMAGE u S -HIRED AUTOS I AUTOS j f -{Per accident :_....._. --...,......_...,_...... ........_._.._........__...�..� --- UMBRELLA LIAB ; OCCUR ( € EACH_OCGURRENCE Is _ _... EXCESS LIAR CLAIMS MADE {$ ! ! DED I RETENTIONS ! i 5 !WORKERS COMPENSATION � l i ! X I STATUTE PER � ER H-,_ ( AND EMPLOYERS'LIABILITY Y!N ' ` �� _L-� A ANY PROPRIETORIPARTNER/EXECUTIVE ` 'MAARP301079 103126120181 03126/2017 j E.L.EACH ACCIDENT_--N S_-.__-_A.___...„500,000 OFFICERIMEM8ER EXCLUDED? NIA! € - -------T i(Mandatory in NH) E.L.DISEASE•EA EMPLOYE 5 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I ! E.L.DISEASE-POLICY LIMIT S 500,000 t t ! i DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Building Department North Andover, MA AUTHORIZED REPRESENTATIVE p 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ^1 WINTE-2 OF ID: JJ ,a►coR[7 CERTIFICATE OF LIABILITY INSURANCE DATE(M7120 05117!206 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not center rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME; Crown Insurance Agency, Inc. PHONNE _ Bradly S.Michals Insurance - - _E ... ._._ Agency,Inc. Laic,No.Exu_617-924-1100 arc no- 617-926-2162 85 Main Street E-MAIL _ I Watertown,MA 02472 ADDRESS: Crown Insurance Agency,Inc. - _€NSURERi5)AFFORDING COVERAGE NAIL N ..... ......... .... .. €NSURERA:Acadia Insurance Company INSURED Winter Hill General Contractor ._ ............._._.----._._... Claudio Mcuhna Araujo INSURER B;Northland Insurance 170 Main St iNSURERC:Arbella Insurance Co, 17000 North Reading, MA 01864 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECI TO WHICH THIS CERTIFICATE MAY BE ISSUFD OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE HEEN REDUCED BY PAID CLAIMS. WSR Aril)17 O R p17LICYEFF POLICYEXP_ LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS B X COMMERCIAL,GENERAL LIABILITY EACH OCCURRENCE $ _T 2,000,00 ...—...__. ....,.. .,._ ___ CLAIMS-MADE X 17AMAGETO RENTETS_ OCCUR WS274235 02/13/2018 02113!2017 PREMISES fi-a(;CCuri-erica)____ $ 100,00 �_,—.----.__— MED EXP(Any one pelsan) $ 5100 PERSONAL S AUV INJURY $ 1,000,00 GENT AGGREGATE LIMIT APDL€r-S PER: GENERAL AGGREGAI E $ 2,000,00 X POLICY PRO- ---___._._ ............. 1. _ LUC PRODUCTS-COMPIOPAGIG. $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMB€NED SINGLE LIMIT�'� 1,UOD,QQ C (Ea acodalill :._......_. ANY Ata FO 1020001551 04/09/2016 04/0912017 BODILY INJURY(Per person} $ ALL OWNED X SCHEDULED BODILY INJURY Per accida. . ....._...._......... .._...__.-_.......... AUTOS AUTOS ( -__d._. nt) $ -- . NON-OWNED _.___. .. X HIRER AUTOS X PROPFRTYDAMA('E - -- AU105 f Per acCEden� $ UMBRELLA HAB OCCUR EACH GCCURRENCF $ EXCESS LIAB .....-._.-- ___.._-...,., .—.__.. _.____-... ..11..1...1.............._, CLAIMS-MA€3E AGGREUArE $ PED RETENTION$ WORKERS COMPENSATION PER OTii- AND EMPLOYERS'LIABILITY YIN X -,STA3 Ul E _ FR A ANY PROPRIETORIPARTNERIEXECUTIVE �NfA WC-20-20-003174-03 03/26/2016 03/26/2017 E.L.EACHACCIDkNT $ 500,00 OFFICE EMBER EXCLUDED? u - (Mandatory in NH) E.L.DISEASE-EA FMPI.OYEF $ 500,00 If yes,describe under ................__.-_�_-.........._.,.._._...... ....._._.._--- ..1.1..1.1........ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY tJMI't $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached€t mare space Is required) �M'•, ----•-- Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY FOR BIDDING ONLY FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDIN (�1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -Office of GOnsumer Affairs&Business I2egatahod j f OME IMPROVEMENT CONTRACTOR J egistratron 168583 : Type: 1 Expiration 3/8Y�p17 Corporation ff WINTER HIL. GENERAL C©NTRALTOR, INC C,LAUDIO ARAUJO ? 170 MAIN S7 I NORTH READING, MA 0,1888 Uaudersecretary, A f Massachusetts -Oertment of Public SafetY n u a ons and Standards Board'of Building Regs� ' �iiii5ii uCilfi ii �iiiii:i viSt� `• License: CS-105185 .p VY � Claudio M 163 Hancock strep N Everett MA 0210 y`r's ai.1tA'` Expiration 07/13/2017 Commissioner